Does Medicare Cover Palliative Care?

Palliative care offers specialized medical support for individuals living with a serious illness, focusing on relief from symptoms and stress to improve quality of life for patients and their families. Understanding how Medicare covers these services is important for beneficiaries and their families. This article clarifies the distinctions between palliative care and hospice care, detailing how Medicare benefits apply to each.

Understanding Palliative Care

Palliative care provides relief from the symptoms and stress of a serious illness. Its primary goal is to improve the quality of life for patients and their families by addressing physical, emotional, spiritual, and practical needs. This holistic support is available to anyone facing a serious illness, regardless of their prognosis or age. Palliative care can be provided at any stage of an illness and can be received alongside curative treatments.

This type of care is distinct from hospice care, though hospice is a specific form of palliative care. While palliative care can be provided concurrently with treatments aimed at curing the illness, hospice care is reserved for individuals with a terminal prognosis who have chosen to focus on comfort rather than curative treatment. Both forms of care aim to enhance comfort and well-being, but they apply to different phases of illness management.

Medicare Part A and B Coverage for Palliative Care Services

Medicare does not offer a standalone “palliative care benefit” but covers various palliative services through its existing Part A and Part B benefits when medically necessary. This coverage applies when a patient is still pursuing curative treatments or has not yet elected the Medicare hospice benefit.

Under Medicare Part B, doctor visits for symptom management and care coordination are covered, including consultations with specialists who focus on pain or symptom control. Outpatient therapies, such as physical, occupational, and speech therapy, are also covered to improve function and comfort. Additionally, durable medical equipment and supplies needed for symptom management, like oxygen equipment or wheelchairs, can be covered under Part B.

Medicare Part A provides for inpatient hospital stays when acute symptom management requires hospitalization. Short-term stays in a skilled nursing facility may also be covered under Part A for symptom management or rehabilitation following an acute event. For these services, beneficiaries face deductibles and coinsurance payments, similar to other covered medical services.

Medicare Coverage of Hospice Care

The Medicare Hospice Benefit, covered under Medicare Part A, represents a comprehensive form of palliative care. To qualify for this benefit, a patient must be certified by both their attending physician and the hospice medical director as terminally ill, with a life expectancy of six months or less if the illness runs its normal course. The patient must also choose to receive hospice care instead of curative treatment.

Once these conditions are met and the patient elects the hospice benefit, care must be provided by a Medicare-approved hospice program. The hospice benefit covers pain and symptom management and overall comfort services. These services include:

• Physician and nursing services
• Medical equipment and supplies
• Drugs for pain and symptom management
• Physical, occupational, and speech therapy

The hospice benefit also includes social worker services, dietary counseling, and grief and loss counseling for both the patient and their family. Short-term inpatient care for pain and symptom management, and short-term inpatient respite care to provide relief for caregivers, are also included. Under the hospice benefit, there are no deductibles or coinsurance for hospice-related services, though copayments up to $5 may apply for some prescription drugs or 5% coinsurance for inpatient respite care.

Accessing Palliative Care Under Medicare

Accessing palliative care services under Medicare begins with a conversation between the patient and their primary care physician or specialist. This discussion should focus on the patient’s serious illness, symptoms, and overall goals of care. A physician can assess the need for palliative care and may either provide the services directly or refer the patient to a specialized palliative care team.

Finding appropriate providers can involve physician referrals, hospital palliative care departments, or online directories of Medicare-approved providers. For those considering hospice care, the chosen Medicare-certified hospice agency will guide the election process. A personalized care plan will then be developed, outlining services to address the patient’s symptoms and support their quality of life.